Papillary Structures

Hello!  Glad this forum exists!  Last year, I had a TAH/BSO because I had a mass that was attached to my right ovary and fallopian tube.  According to pathology, this 'mass' was benign, but had papillary structures inside it.  The doctor kept giving me conflicting information, such as at one point, he said it was precancer or cancer, but then at another, he said it would have definitely 'become' cancer if I had left it alone.  My question is this, why go to the trouble of a TAH/BSO when I didn't have cancer, when the mass was 'benign,' etc.?  A friend [who, is, of course, not a doctor] said that 'nothing' benign has papillary structures.  Is this true?  Does that mean this 'mass' was actually borderline?  Or would have pathology stated such?  Sorry for all the questions!  THANKS!

[Annekathryn Goodman, M.D.]

Hi There,
you have good questions. I would like to ask a favor though. Can you see if you can get the actual pathology report from your surgery? If you could post the actual wording of the report for me, I can translate it for you and explain it.
looking forward to hearing more from you. Thank you!

[Murray2]

Sorry, should have been WAS NOT cancer or precancer.  Typing fingers flew too quickly across the keyboard!

[Murray2]

Actual pathology from the OBGYN who did the surgery or from the hospital?  Thanks for your speedy response!

[thepurselady]

Your ob should have the pathology report in his files.  Can you call them and have them fax them to you or can you pick up copies?  

[Murray2]

They can fax.  That's how I got the original results.  I don't have them anymore, it seems.  Tore the house apart looking for it, but the OBGYN who did the surgery should fax it with no problem.

[thepurselady]

Awe I lost some of my lab works also, drove me nuts just when you need it its so hard to find!

[Murray2]

Here is the text of my pathology report.  They faxed it to me this morning.  Thanks for all your assistance!

Received is a uterus with detached bilateral fallopian tube and ovaries and a detached cervix.  The cervix measures 4.9 cm in length x up to 2.7 cm in diameter.  The cervical lips are tan and fleshy.  No erosion is noted.  There is a punctate os.  The uterus measures 7.3 cm in length x up to 5.5 cm in greatest fundic diameter.  The cervix and the uterus have an aggregate weight of 115 grams.  There is a bulging area on the posterior aspect of the uterus measuring up to 1.7 cm in greatest dimensions.  No adhesions are noted.  The cervix is opened and sectioned.  Opening the uterus reveals glistening-tan endometrium measuring 0.6 cm in thickness and myometrium measuring up to 1.9 cm in thickness.  Multiple transactions reveal no mass within the uterus.  

The right fallopian tube measures 6.4 cm in length x up to 0.8 cm in diameter.  There is a frond-like fimbriated end.  There is a peritubular cystic structure measuring 7.5 x 6.2 x 5.0 cm.  Sectioning the cystic structure reveals clear serous fluid and multiple gray to white papillary structures measuring up to 1.2 cm in greatest dimensions.  The papillary structures are attached to the cyst wall.  The serosal surface in the area of the papillary structures is marked with black ink.  The ovary has been previously detached from the fallopian tube.  It measures 4.0 x 2.5 x 3.0 cm.  The serosal surface is tan and bosselated.  Multiple transections reveal a corpus albicans measuring up to 0.6 cm in greatest dimensions, a corpus luteum measuring 0.7 cm in greatest dimensions, and a cystic structure measuring up to 2.0 cm in greatest dimensions.  No mass is noted within the ovary.

The left fallopian tube measures 5.5 cm in length x up to 0.6 cm in diameter.  There is a frond-like fimbriated end.  The serosal surface is tan and smooth.  No adhesions are noted.  Multiple transections reveal no mass or dilation within the fallopian tube.  The ovary measures 3.9 x 2.4 x 2.7 cm.  The serosal surface is tan and bosselated.  Multiple transections reveal corpus albicans measuring up to 0.4 cm in greatest dimensions, and multiple cystic structures measuring up to 0.8 cm in greatest dimensions.  No mass is noted within the ovary.

[akg]

ok, you are almost home. What you so kindly put down is called the "gross specimen" It is a visual description and measurement of how everything looked (to the naked eyeball). Now on that same report, there will be a section called "histologic" or "microscopic'. On most pathology reports, it comes before the gross description and sometimes it is just a few lines long. It is that microscopic diagnosis that is key. Based on what you have put down, your uterus sounds normal and your ovaries sound normal. It is that right "peritubular structure" which measures 7 cm that is the thing we want to see under the microscope.
thanx for doing this!

[Murray2]

Ya know, there isn't a section like that on my pathology report.  Nothing labeled such as you describe.

[Murray2]

Allow me to correct that statement.  There is a section labeled 'Microscopic Description.'  Underneath are only a few words:  Microscopic examination examination performed.  

There is no elaboration.  My thing is, if I didn't have anything clearly wrong or any adhesions or endo, why the TAH/BSO?

[akg]

hmmm... ok, here is my suggestion. Please call the pathology department of the hospital wherre you had your surgery. Tell them that your pathology report is incomplete because there is no microscopic diagnosis. It could be that you received a preliminary report and the final report is on another piece of paper. Good luck!!

[Murray2]

I have already called the hospital to obtain a copy of my medical records.  I just have to find time to pick it up.  However, it seems from what you have interpreted by reading the 'gross description,' everything looked dandy outside the 'peritublar structure' with papillary structures inside.  I'm sitting here wondering why I needed a hysterectomy at all.  There was no scar tissue [as I was told by the OBGYN], there were no adhesions [as I was told by the OBGYN], and apparently nothing else alarming.  I could have understood losing the right tube and perhaps the right ovary, but EVERYTHING?  I'm as stunned today as I was the day I was told I would need this surgery.

[Murray2]

Good afternoon.  I received my surgical report and the pathology report from the hospital this afternoon.  Free of charge!  YAY!  

There are conflicting reports of what they found.  The surgical report noted that the 'mass' was solid, not cystic where the pathology report noted it was 'cystic.'  Surgical report details how I had pelvic and colon adhesions as well as a 'lesion' on my left ovary.  The 'solid mass' on my right ovary was attached TO the right ovary, where path stated it was 'peritubular,' which I took as meaning coming FROM the tube.  Not the ovary.  According to the surgical report, I had a small bowel obstruction as well.  Path report notes no adhesions.  No mention of endo.  No mention of any of these things.  There is also still NO 'microscopic' description on the path report I received from the hospital.  I am pulling my hair out by the roots because I am so frustrated.  Also, the surgical report stated that I had a large complex cyst on my right ovary in addition to the mass.  My ovary was also enlarged to about 6 cm.  

So...I'm totally confused.  Why is there conflicting information?  What do I trust?  The surgical report or the path report?  And why isn't there a stinking microscopic description?  If it's benign, tell me WHY it is.  UGH!  

Thank you so much.

[akg]

Hello again,  What I would suggest is to make an appointment with your OB Gyn , bring the reports that you have, write your questions down in advance and have a good heart to heart. Nothing is like a nice relaxing chat to sort out most issues!
As a general rule, the microscopic report is the most important part of the report. It is from the microscopic that one gets a diagnosis such as: cancer or endometriosis or fibroid and so on. The gross description is just descriptive.

OK here is a silly analogy: You have a cake.
Gross  description: brown , 10 inches, round
Microscopic description: chocolate icing, walnuts inside the cake, cake made with eggs and butter.

take care

[Murray2]

My doctor probably won't see me to answer these questions.  Every time I ask him a question, he tried to dismiss my worries.  I don't like him.  I don't trust him.  I do not want to see him to be frankly honest.  I don't know any other way of getting the information.  I suppose I just won't ever know.